单绒毛膜双羊膜囊双胎选择性宫内生长受限的相关因素

目的:探讨单绒毛膜双羊膜囊双胎选择性宫内生长受限(sIUGR)的相关因素及围产儿结局。方法:2010年03月-2012年02月暨南大学第二临床医学院产科分娩双胎妊娠301例,单绒毛膜双羊膜囊双胎sIUGR31例作为病例组,双绒毛膜双胎sIUGR 29例作为对照组1,同期分娩的无sIUGR单绒毛膜双羊膜囊双胎30例作为对照组2。病例组根据胎儿脐动脉舒张末期血流频谱分为I、II、III型。记录新生儿出生体重、胎盘重量,脐带插入情况及围产儿结局。体重轻者称小胎,体重正常者称大胎。结果:病例组、对照组1及对照组2围产儿死亡率为17.7%(11/62)、5.2%(3/58)及1.7%(1/60),P<0.01,脐带帆状插入率为46.88%,6.97%及13.33%,P<0.01;病例组I、II、III型胎儿宫内死亡率分别为3.6%(1/28)、19.2%(5/26)及12.5%(1/8),P<0.01;病例组大、小胎胎盘重量为(480±130)、(260±90)g,P<0.05。结论:单绒毛膜双羊膜囊双胎sIUGR围产儿死亡率明显升高。I型围产儿结局良好;II型易出现围产儿死亡。其相关因素主要有胎盘份额分配不均衡及脐带帆状插入。

A study about the associated factors of monochorionic diamnotic twin pregnancies with selective intrauterine growth restriction.

Objective To evaluate the perinatal outcome of monochorionic diamnotic(MCDA)twin pregnancies with selective intrauterine growth restriction(sIUGR)and its associated factors.Methods From March 2010 to February 2012,there were 301 cases of twins had been delivered in our Hospital.31 cases of MCDA twins with sIUGR and 29 cases of dichorionic(DC)twins with sIUGR(control group1)were selected from the aboved twins,there were 30 cases selected by random method from the MCDA twins without IUGR(control group2).The MCDA sIUGR group were classified into I、II、III types according to the characteristics of umbilical artery diastolic flow.placental weight and cord insertion were recorded when the twins were born.Results The overall incidence of perinatal death in the MCDA sIUGR group was higher than that in the control group(17.7% vs 5.2%,1.7%),P<0.01;The rate of velamentous cord insertions is 46.88%,6.97% and 13.33%,P<0.01;The rate of intrauterine fetal demise(IUFD) was 3.6%(1/28)、 19.2%(5/26)、12.5%(1/8),P<0.01;In the MCDA sIUGR group,the mean placental weight of the larger and smaller twins were(480±130)g and(260±90)g,respectively, P <0.05.Conclusion It is a higher incidence of perinatal mortality for MCDA sIUGR twins;Type I cases,with a fairly good outcome,Type II is associated with a high risk of intrauterine fetal demise;The major associate factors of MCDA sIUGR include uneven placental sharing and velamentous cord insertions